Developing human resource for health
Several studies have shown that Human Resources for Health (HRH) are pivotal to attaining, sustaining and accelerating progress towards Universal Health Coverage (UHC).
According to the World Health Organisation (WHO), a strengthened health policy environment is critical to the delivery of quality health care to the population as it creates an enabling environment for the health workforce; and that health services, particularly at the primary health care level, are critical to Maternal, Newborn and Child Health (MNCH), and can be only as effective as the persons responsible for delivering them.
Unfortunately, in Nigeria, there is critical shortage in HRH. But there are efforts to optimise the available workforce in the provision of quality essential services towards realisation of UHC.
As part of efforts to improve HRH in Nigeria, the Minister of State for Health, Dr. Osagie Ehanire, has called on governments at all levels and private sector alike to develop human resources that would enhance the provision of quality healthcare services in the country, admitting that the shortage of health workforce and the uneven distribution of available skilled healthcare professionals have been identified as reasons for poor healthcare service delivery in Nigeria.
Ehanire told journalists that it is necessary to raise awareness on the health workforce challenges and issues hindering service delivery and the attainment of health national targets including that of Sustainable Development Goals (SDGs) as well as to address the shortage of human resources in the health sector.
He explained that all initiatives introduced to achieve UHC would be feasible if there were adequate human resources to render health services. “All the initiatives to achieve Universal Health Coverage will be appropriate if the right numbers of people with the right skills are in the right place at the right time with the right attitude to provide the right service at the right cost.”
Ehanire added that strengthening the workforce is therefore a logical step in the right direction, which is the main thrust for the 3rd National Human Resources for Health Conference 2017.
The Permanent Secretary, Federal Ministry of Health, Binta Adamu-Bello said it is paramount to reinforce the awareness of the health workforce challenges and issues hindering service delivery and the attainment of health national targets.
Director, Health Planning Research and Statistics, Federal Ministry of Health, Akin Oyemakinde, said that in 2010, the National Council on Health directed Federal, States and the FCT administration to establish human resources sections for health desk offices in the Ministry of Health adding that analysis conducted few years later revealed that many states have not complied with the directive, as the report also revealed that most states do not quite understand the roles and responsibilities of human resource for health desk hence, the hosting of Human Resources for Health Conference in 2011 and 2013 respectively.
Also, as part of efforts to boost HRH, Save the Children International (SCI) is set to train 5,000 workers across Lagos, Kaduna and Gombe states.
SCI is an International humanitarian and development organisation working for the survival, protection and development of children, globally. SCI’s work in Nigeria started in 2001 with head office in Abuja and branches in the following states: Bauchi, Katsina, Zamfara, Yobe, Jigawa, Gombe, Kano, Lagos, Enugu and Kwara. The organisation’s focus is on the critical areas of child survival, newborn care, and child protection, nutrition, education, and participation.
SCI at a three-day Health Workers Capacity Building (HCB) workshop said the project is one of its collaborative interventions with the government, targeted at strengthening the skills of health workers to be able to deliver efficient MNCH services as well as push for the creation of a sustainable enabling policy environment for the delivery of quality services in Lagos state.
Advocacy Adviser, Save the Children Nigeria, Mrs. Folake Kuti, believes the workshop is important to achieving sustainable engagement and policy influencing by stakeholders.
Kuti said the government in Nigeria needs evidence to convince them to do what you want them to do. “We are trying to develop tools to craft messages to convince policy makers that this is very necessary to the people. When you have evidence and write advocacy messages with data to back it up the government will listen we are trying to sharpen the tools of our health union workers.”
Kuti noted that some of the health workers are trained with obsolete equipment and practices. A lot of things are evolving every day, a lot of knowledge and skills. What we have been doing is to strengthen them, to refresh and remind them what they have been taught.
Her words: “Most of the time people die is through negligence and lack of knowledge and also because of lack of research. Times are changing and the training is meant to sharpen their skills.”
Kuti said the SCI through HCB project has, Since 2014, been equipping health workers across both the public and private health sector across Lagos, Kaduna and Gombe states, to acquire best practise knowledge and skills in MNCH. These interventions, she said, include new vaccine administration, vaccine management, and Integrated Management of Childhood Illness (IMCI) among others.
Kuti said the Essential Newborn Care (ENC) course is one of SCI’s ongoing interventions under the HCB project. “Save the Children provided some charts to selected PHCs whose staff were trained on the HCB project. ENC is an integrated approach that comprises Helping Babies Breathe (HBB), Essential Care for Every Baby (ECEB), and the Essential Care of the Small Babies (ECSB),” she said.
Area Operations Manager, Lagos and Cross River, SCI, Roy Chikwem, said their approaches include improving access to basic MNCH services in communities through training of health workers to treat common childhood diseases and to educate mothers on the prevention and home care practices to ensure the early detection and prompt case seeking.
Chikwem explained that HBC project is meant to solve challenges facing the health care sector today. “That is why to achieve this, we have to enable that health workers are correctly applying improved skills and knowledge in the provision of MNCH services in the targeted states.”
Meanwhile, MNCH Adviser, Dr. Opeyemi Odedere, said that ensuring capacity is one of the objectives of the project, which they are presently implementing. It is basically a health-strengthening project and more essentially to build capacity of health workers in the state and to do it; the knowledge and skills of health workers will improve and be able to provide good quality services, which is the ultimate goal.
Odedere added: “This basically trying to improve capacity with major stakeholders, advocacy groups, the media to be able to fine tune the skills to enable in the area of presenting tools in a well structured manner to decision makers in other to influence them and make good decisions that will help the people. It is very important because there are steps you need to take in identifying issues and finding solutions and seek for political will.”
Advocacy Officer, SCI, Ms. Adetokunbo Lawrence: “Our quest is to improve strategic engagement work for policy change by CSOs and Health workers which are critical to healthcare service delivery and in recognition of your passionate work in promoting healthcare delivery, government accountability and other dimensions of development in the state.”
She revealed that SCI under the auspices of HCB project- one of its collaborative interventions with the state government targeted at strengthening the skills of health workers to be able to deliver efficient MNCH services as well as push for the creation of a sustainable enabling policy environment for the delivery of quality MNCH services in Lagos state.
“I believe this training is important to achieving sustainable engagement and policy influencing by stakeholders,” said Tokunbo.
Lawrence added: “SCI continues to demonstrate its commitment to saving the lives of children, and to creating an enabling policy environment for the health workers that delivers quality MNCH services. This commitment is currently being demonstrated through the HCB project. The main objective of HCB is to improve the quality of health care available to mothers and their children. Save the children works with partners to scale up innovative solutions to making the world a better place for children. No mother should die giving life to her child, and no child should be born to die.”
Issues being deliberated at the workshop includes: SCI’s theory of change, Johns Hopkins Smart: What is Advocacy and Theory of Change, Building Consensus to determine broad goal, SMART objective and Decision Maker and Focus Efforts on External opportunities and challenges among others.
Kuti added: “The workshop is set to build capacity and collaboratively develop policy advocacy briefs and generate plans for advocacy and consolidate common efforts in support of the delivery of quality MNCH services for children and their mothers and to improve strategic engagement work for policy change by Civil Society Organisations and Health workers which are critical to healthcare service delivery and in recognition of your passionate work in promoting healthcare delivery, government accountability and other dimensions of development in the state
“Though, the Nigerian government has demonstrated priority as can be seen in the recent attention accorded to HRH planning, distinct from general human resources. For example, in Lagos state, the primacy of HRH towards achieving UHC and Sustainable Development Goals (SDGs), can be seen in the review of Lagos state HRH Policy, Situation Analysis (SA), and HRH Strategic Plan, and more recently, in the domestication of the national Task Shifting- Task Sharing (TSTS) policy in the state….”
“In the same vein, the revision of the national curriculum for the training of Community Health Extension Workers (CHEWs) has set the right climate for pre- service institutions to begin to groom upcoming health work force for the task ahead. The revision of the curricula for the training of community health practitioners was necessitated by the need for HRH alignment with global initiatives. Nonetheless, all of these have majorly focused on facility level health workers, and little attention has been accorded those at the community level.
“Despite the significant progress, attention is still lacking in terms of HRH at the community level for the delivery of primary health care. This takes a particular look at the role of CHEWs, and their place in towards the achievement of UHC. It also calls upon the Government and other state actors to prioritise the CHEW cadre in the state’s HRH.”
Several studies have shown that CHEWs are critical to health coverage as they are responsible for reaching the most vulnerable and the hardest- especially newborns, children and their mothers. The vital role of CHEWs in the delivery of essential services was since outlined in the Alma-Ata Declaration, which states that primary health care “relies, at local and referral levels, on health workers, including physicians, nurses, midwives, auxiliaries and community workers as applicable, as well as traditional practitioners as needed, suitably trained socially and technically to work as a health team and to respond to the expressed health needs of the community”.
In line with the recently domesticated TSTS policy in Lagos state, the new curriculum supports the standardization of the training of HRH and promotes compliance to ethical guidance on tasks shared or transferred among the different cadres of health workers in the state, in this instance the CHEWs. The new courses in the curricula include: Essential Newborn Care, Community Based Newborn Care and Family Planning. Some other courses have new names, while the content of some courses have been expanded with new topics, such as Integrated Community Case Management of Childhood Illnesses (iCCM), Primary Health Care Under-One Roof, and National Health Act. All of these are in line with Save the Children’s goal of guaranteeing lifesaving health care for every newborn and every last child.
This will improve the skills of the community health practitioners and enhance their performance in the provision of Community Health Care services. This is important because community health practitioners form the bulk of frontline health workers in Nigeria especially in rural areas and is central to the country’s attainment of its health goals.
With the milestones articulated in the Every New Born Action Plan, ENAP (2013), Save the Children is convinced that greater investments are needed in health workforce capacity and support and community engagement.
The organisation thereby called on the government, and other related health institutions Ministries, Departments and Agencies (MDAs) for training and re-training of frontline health workers, at both facility and community levels, integrate costed human resources for health strategy into Reproductive Maternal Newborn, Child and Adolescent Health (RMNCAH) plans and ensure sufficient financial resources are budgeted and allocated.
The non for profit body also wants participation of communities, civil society and other stakeholders to increase demand and ensure access to and coverage of essential maternal and newborn care, by using and improving programmatic coverage data including equity and quality gap assessments and adapt and use a minimum prenatal dataset, implement maternal and prenatal death surveillance and response.